title: Clinical guidance of community physiotherapists regarding people with MS: professional development and continuity of care.
abstract: OBJECTIVE
  Clinical guidance to community physiotherapists (cPTs) is an integral part of physiotherapy service offered in hospital outpatient (OP) clinics for people with multiple sclerosis (PwMS). There is currently a lack of knowledge on the significance of such guidance. The aims of this study were 1) to identify the features that cPTs perceive to be significant in clinical guidance and 2) how this guidance may affect the cPTs' subsequent treatment of PwMS.
  
  
  METHODS
  A phenomenological-hermeneutical framework was selected, and qualitative research interviews were performed and complemented with non-participating observations of a strategic sample of nine cPTs who received clinical guidance for their patients. The interviews were recorded and transcribed, and content analysis was conducted by using systematic text condensation, using theories of practice knowledge as analytic perspectives.
  
  
  RESULTS
  The results indicate that cPTs identify participation in authentic movement analysis of a familiar patient as significant for professional development. Vital features are evaluation of the interplay between body parts, exploration of improvement of movement embedded in the OP clinic physiotherapist's explanations, followed by discussion. These elements provide access to dynamic elements in practice knowledge that are available only through first-hand experience and promote clinical reasoning through enhanced reflection during action as well as following action. Such guidance suggests direction for subsequent treatment and may enhance the continuity of care, particularly if the cPTs are experienced. Mutual information flow implementing the cPTs' perspective is requested, as are the use of plain language and supervision of the cPTs handling skills. Professional guidance for cPTs in OP clinics for PwMS should be considered when programmes aiming to develop competency in neurological physiotherapy are designed and when continuity of care for PwMS is discussed. More research regarding potential long-term impact of professional guidance in these clinics is requested.
authors.affiliation: Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway; Department of Physiotherapy, Nordland Hospital Trust, 8092, Bodø, Norway.
authors.forename: Britt
authors.initials: B
authors.lastname: Normann
authors.forename: Knut W
authors.initials: KW
authors.lastname: Sørgaard
authors.forename: Rolf
authors.initials: R
authors.lastname: Salvesen
authors.forename: Siri
authors.initials: S
authors.lastname: Moe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003266:Continuity of Patient Care / Q000639:trends*; D004517:Education, Professional / Q000639:trends*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000628:therapy*; D009664:Norway; D010348:Patient Care Team; D059825:Physical Therapists / Q000193:education*; D017410:Practice Guidelines as Topic
keywords: multiple sclerosis; physiotherapy; professional competence; qualitative research; supervision/mentoring